Documentation, monitoring, and communication practices in opioid administration: A cross-sectional study in Gaza -Palestine

Introduction: The global opioid crisis has prompted urgent attention to safe medication practices, especially in critical care environments. In the Gaza Strip, challenges such as resource scarcity, displacement, and high workloads compound the complexities of opioid management. Aim: This study aimed to assess the level of compliance with opioid medication policies among nurses in Intensive Care Units (ICUs) across Ministry of Health hospitals in Southern Gaza. Methodology: A cross-sectional descriptive analytical design was employed, targeting all ICU nurses (n = 126) at three major hospitals using a structured self-administered questionnaire. The tool evaluated compliance across three core domains: monitoring practices, nursing interaction (handover and communication), and documentation procedures. Results: The results revealed that documentation practices had the highest compliance (83.75%), followed by monitoring practices (74.00%) and nursing interaction (73.00%), with an overall mean compliance of 76.25%. No statistically significant gender differences were found in compliance levels. However, factors such as displacement, heavy workloads, and lack of recent training negatively impacted adherence. The findings underscore the critical need for targeted training programs, supportive institutional policies, and robust monitoring systems to enhance opioid safety practices. Improving communication channels and ethical reporting mechanisms is also essential. The study concludes that while technical adherence is relatively strong, systemic barriers remain. Conclusion: Adherence to opioid policy among ICU nurses was moderate to high, with the highest compliance in documentation (83.75%), followed by monitoring (74.00%) and nursing interaction (73.00%). The strongest practices included opioid storage and dosage verification, while the weakest were error reporting and ethical issue observation. No significant differences were found across demographic factors; however, ICU experience and workload positively influenced adherence. Although formal training showed no significant impact, those trained before or during the war had slightly better monitoring scores. Workplace conditions and ICU-specific experience appear more influential than demographic or educational factors. Recommendations: include periodic education, policy reinforcement, and supportive supervision to strengthen compliance and patient safety in Gaza's ICUS.